Health & Development Survey

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Dear Parents:
You are invited to participate in our survey regarding your child's health and development.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point.

Your responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential.

I Agree

How would you describe your child's birth and delivery?

When was your child delivered?

List any complications:

List anything else you deem important regarding birth and delivery :

At what age did your child first sit alone?

At what age did your child crawl?

At what age did your child walk?

At what age did your child speak first words?

At what age did your child first speak in sentences?